Dupree, John A.

NCAMA / ❑ DRE�GE & FILL '',t t 1k., '. f f.; 1 ' 1, �_.. NO. 75226
--. A B C D
GENERAL? PERMIT Previous permit#
LJNew ❑Modification LIComplete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant tol SA NCAC
❑ Rules attached.
Applicant Name Project Location: County _
Address Street Address/ State Road/ Lot #(s) _
City State ZIP I
Phone # (. _ )-
Authorized Agent
Affected
❑CW
AEC(s):
❑OEA
Ll PWS
ORW:
yes / no
I c;:
--E-Mail
DEW DPTA Ll ES ❑PTS
❑HHF EIH ❑UBA ❑N/A
PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Groin length
number
Bulkhead/ Riprap length__
avg distance offshore_
max distance offshore_
Basin, channel
cubic
Boat ramp _
Boathouse/
Beach
Other
Shoreline Length I!
SAV: not sure yes no -I-
Moratorium: n/a yes no I_
Photos: yes no
Waiver Attached: yes no 1
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature *` Please read compliance statement on back of perit**
App on Fee(s) Check#
s's
Subdivision
City ZIP_ _
Phone # (^fir) River Basin
I Adj. Wtr. Body ! (nat /man /unkn)
Closest Maj. Wtr. Body_
(Scale:
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Si na ure
Issuing Dat Expiradonradon Dr at/

ewrERAI PER
❑Modification ❑Co
As authorized by the State of North Carolina,
and the Coastal Resources Commission ig an a
Applicant
AG ,r
Phone #,j 54A:�
wf o-. t r ' "` -No. 75226
7 T A B �p
:t. Reissue ❑Partial Reissue \� Previous permit # f
Date previous permit issued_
ment of Environmental Quality
environmental concern pursuant to I SA N v
es att he .
Project Location: County
Street Address/ S to Road/ Lot #(
ZI i
r
Authorized Agent---
Affected LICW
7cW
PIA ❑Es ❑PT5
AEC(s): OEA
HHF
J lid ❑ UBA ❑ N/A
❑ PWS:
ORW: es / no
PNA
yes
Type of Project/ Activity
Pier (dock) length
Fixed Platform(,)
Floating Platform(,)
Finger pier(s)
Groin length
number
Bulkhead/ Popmp length
avg distance offshore j
max distance offshore
Basin, channel
Boat ramp
Boathouse/
Beach
Other
shoreline Length _
W: notsure
loratorium: n/a
hotos:
Jaiver Attached:
building permit may be required by:
Note Local Planning jurisdiction)
otes/ Special Conditions Ar
It or Applicant Printed Name
Phone # cw
Adj. Wtr. Body
Closest Mal. Wtr.
er Basin
A ❑ See note on back regarding River Basin rules. I
tur�Please read compliance statement on back of per it**read compliance statement on back of per its`,`
cat�Fee(s)
Check#

�10
AL C_ fV7 RIPARIAN PR©PQTY )V NER STATEI Ei Ll
I hereby certify that I own property adjacent :o :Ipj
property located at ( C�) v} D r
(Address, Lot,
one Q rZGti, x-a ;� �Ykti.S in
(Waterbody)�
(Name
tylTown andlor County)
I
The applicant has described to me, as shown below, the development proposed at the above
Ioc ti .
I have no objection to this proposal.
I have objections to ;his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to w ve the setback, you must initial the appropriate blank below.)
_ 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 1 setback requirement.
(Property Owner Information)
4 J�nr%rV�%l�
Print or Typo Name
Malling Address
City/Sfat�:Lip
-----
To!ophone Numbsr
i�01C
(AdtAcent Property Owner Information)
but
(Revrsed 61f 8,"1014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to : oh B . t's
(Name of Prop rty Owner)
property located at I J� vJy 5 rl C' w no r-1 >\i CW 7 C
1 (Address, Lot, Block, Road, e c.)
on CC V,C� i-Sc;'M�JsyofeS _,in O NC- N.C.
(Waterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
_I I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must III/ in description below or attach a site drawing)
— vwct iv\1 �v�Gvv CSZ_ , n C 0. vN ci t tXn d Q r ci r' c1
b 4)k.-t.J bc,,, - L , _� (mot' 4-0 p c-o p e d l-i LL-r, e_ c .(-
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish to
waive the setback, you must initial the appropriate blank below.)
✓ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Date
(Adjacent Property Owner Information)
Date
(Revised 6/1812012)

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